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J Matern Fetal Neonatal Med. 2013 Mar;26(5):503-6. doi: 10.3109/14767058.2012.739221. Epub 2012 Nov 8.

Severe sepsis and septic shock in pregnancy: indications for delivery and maternal and perinatal outcomes.

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1
Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinanati, Ohio 45267-0526, USA. snyder.candice@gmail.com

Abstract

OBJECTIVE:

To report maternal and perinatal outcomes in obstetric patients with severe sepsis and septic shock.

METHODS:

We performed a retrospective study of obstetric patients admitted to an intensive care unit (ICU) for severe sepsis/septic shock. Maternal clinical characteristics, hemodynamic profiles, laboratory findings, and perinatal outcomes were evaluated. Patients with severe sepsis (N = 20) and septic shock (N = 10) were compared using Fisher's Exact and Mann-Whitney U tests.

RESULTS:

Pyelonephritis was the most common etiology overall (37%) and acute respiratory distress syndrome (ARDS) was the most common organ injury in both severe sepsis (50%) and septic shock (80%). Liver dysfunction was present in cases with increased morbidity as a late finding and was the least frequent organ injury. Patients with septic shock had significantly higher rates of disseminated intravascular coagulation (DIC) (p = 0.01), altered mental status (p ≤ 0.001), total bilirubin >4 mg/dl (p = 0.04), failure in ≥3 organ systems (70% vs. 15%, p = 0.005), and maternal death (30% vs. 0%, p = 0.03). All patients with septic shock were delivered during hospitalization vs. 40% with severe sepsis. 71% of viable pregnancies required emergent cesarean delivery, and 50% of these for worsening respiratory function.

CONCLUSIONS:

ARDS is frequently found in critically ill obstetric patients with severe sepsis/septic shock and is associated with a high risk of emergent cesarean delivery.

PMID:
23075279
DOI:
10.3109/14767058.2012.739221
[Indexed for MEDLINE]
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